Organization
CMC-NORTHEAST, INC
Active
Parent organization
CMC-NORTHEAST,INC
Other names
NE Pediatric Endocrinology, Huntersville
Organization subpart
Yes
Provider details
NPI number
Legal business name
CMC-NORTHEAST,INC
Authorized official
FRIEDA M LOWDER (VP PHYSICIAN SERVICES COORD)
(704) 783-4146
Entity
Organization
Contact information
Practice address
16623 BIRKDALE CMNS PKWY, SUITE 110, NE PEDIATRIC ENDO, HUNTERSVILLE, NC 28078-5621
(704) 987-4277
(704) 987-5096
Mailing address
16623 BIRKDALE CMNS PKWY, SUITE 110, NE PEDIATRIC ENDO, HUNTERSVILLE, NC 28078-5621
(704) 987-4277
(704) 987-5096
Taxonomy
Speciality
Code
Description
License number
State
2080P0205X
Pediatric Endocrinology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
015Y2
BCBS GROUP ID
NC
01
—
355573
MAMSI
NC
01
—
4462028
AETNA
NC
01
—
566000156074
TRICARE STANDARD, NON NWK
NC
05
—
5903854
—
NC
01
—
I902
PARTNERS MEDICARE CHOICE
NC
Enumeration date
01/18/2007
Last updated
08/22/2007
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